title: Mitral valve repair in a patient with mesocardia.
abstract: A 75-year-old man was referred for treatment of mitral valve prolapse secondary to tendon rupture. He had been receiving oral and inhaled corticosteroids for bronchial asthma and bronchial ectasia. Chest X-ray showed cardiomegaly with protrusion of the right atrium shadow. Computed tomography revealed dislocation and counterclockwise rotation of the heart with the apex of the heart located in the mid-thorax, indicating mesocardia. We believed that it would have been difficult to expose the mitral valve through a right-sided left atrial approach. Thus, we planned to perform mitral valve repair via a trans-septal approach. The right thoracotomy approach was not suitable because of respiratory dysfunction. After a median sternotomy, the left anterior descending coronary artery was identified just beneath the midline of the sternum. Even after decompression of the heart under cardiopulmonary bypass, we could not obtain a good view of the right side of the left atrium. By a transseptal approach with a self-retaining retractor and atrial hooks, we obtained adequate exposure of the mitral valve and performed the mitral valve repair uneventfully.
authors.affiliation: Department of Cardiovascular Surgery, Osaka City General Hospital, Osaka, Osaka, Japan.
authors.forename: Akimasa
authors.initials: A
authors.lastname: Morisaki
authors.forename: Koji
authors.initials: K
authors.lastname: Hattori
authors.forename: Manabu
authors.initials: M
authors.lastname: Motoki
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Nishimura
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Shibata
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D012857:Situs Inversus / Q000000981:diagnostic imaging*; D056346:Sternotomy; D014057:Tomography, X-Ray Computed